Avsnitt
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I give my perspective on being an APP in the ED, be humble and teachable and strike an affect that allows the physicians to speak into your practice
When in doubt, consult the specialist
Julie talks about what makes her proud about her career
She is proud of the connections she made, that she treated her patients how she would have wanted to be treated
Remember to take that intentional time with patients to help reassure and connect with them
Julie talks about a the expectation she sets for patients with abdominal pain - that we don’t find a clear answer most of the time and when we do it’s usually something emergent and surgical so sometimes no answer is good news
Set the right expectation for the ER visit early
She talks about how she reassures patients that may be embarrassed for coming in when they end up not having anything emergent going on
Julie highlights the need to eat and hydrate on shift
Julie talks about the next generation of providers and how she hopes they continue to keep their observation skills and clinical thinking skills intact considering technology advances and AI incorporation
Julies advice to her younger self would be to not let people drag you down
A big thing we need to learn is to not let others poor behavior or flexing of their ego affect us personally, it speaks more about them than us
We need to learn to give constructive criticism without judging
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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Mindsets to avoid burnout – Julie humanizes the patient and understands that whatever difficult things we are dealing with are temporary and have gratitude
We must constantly recognize possible anchor bias and avoid cynicism to appropriately treat our patients
We talk about our interactions with EMS
Both Julie and I remember working in EMS and the value that EMS brings in their report because they often see a lot of things we don’t get from the history of the patient
Julies advice for the new APP/ER doc - don’t come to premature closure on a diagnosis, don’t be afraid to ask questions, pay off your loans over buying the biggest house and latest toys
We talk about the baseline level of stress we deal with
We talk about technological changes over time and imaging improvements
She talks about the challenges that the Covid pandemic presented and the shortages of different things we have now encountered
Julie still finds meaning in finding the hard differential diagnosis and working towards positive patient interactions, the teamwork in the ER
I talk about the importance of creating an approachable affect so everyone feels free to voice concerns
Go look at the patient when the nurse is concerned
Julie talks about the benefit for new EMT’s and paramedics to reach out and ask for feedback and follow up on their patients, often we don’t have time to pull them aside
EMS doesn’t have the best mechanisms in place for good feedback on every case like we do in the ER, where we see in real time how accurate our assessment may have been when the work up comes back
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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Saknas det avsnitt?
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Started out her medical career as an EKG tech and in EMS as an EMT for one of the first ambulance companies in the area
She saw the disconnect between the provider that people wanted to become and who they became, and she didn’t want that to be true for herself
She became an attending in 1991 and now has close to 40 years in emergency medicine
She became a physician when it was predominantly a male field
Julie talks about some of the things that have changed over time
We need to have empathy for the people that come in for non-emergent complaints and realize that we have the honor in the ED to fill all the gaps in the wider medical system
We talk about the increase in transparency with patients and the access they now have to their lab work, imaging and chart and this helps us increase trust with patients
Julie talks about a paramedic partner she really admired and how well she treated patients, and how there wasn’t a lot of female role models for her in med school
I talk about how I also had partners that really improved the trajectory I was on as a new EMT
Seek first to understand is one of the 7 habits of highly effective people and this relates directly to taking care of patients
Julie talks about how it was to be a woman in medicine and how her voice got dismissed as well as the dynamics that are at play with patients
Julie talks about burnout and how labyrinth therapy helped her. How you need something that helps you look beyond yourself to have a moment of awe and gratitude
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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Brian talks about his experience being on the “other side” of the bedside with his wife’s cancer treatment
He really appreciated the extra time that the doctors spent with him and his wife to explain things – repetition is very helpful for your patients to really hear you
Brian talks about balancing fatherhood and being a husband with our emergency medicine schedules and the challenges of being in a physician couple
You have to figure out family priorities and what works well in your situation
Date night is the most important investment you can make
We talk about how to transition from ER mode to husband and father mode
Brian talks about how finishing his notes helps to make his mind move on or answer some questions he may have to resolve a conflict he might be having
We talk about church attendance as Christians
Brian tells a powerful story where he was able to save and prolong a patient life so he could talk with his family
“Sometimes it’s more important to help someone die than to help them live”
We need to be intentional about remembering the big and the small good things that happen throughout our day
You never know when you might be the last person to interact with someone and may make the difference between them, deciding to give the ER another chance
Brian talks about advice to his younger self – don’t work as hard, take more time off
Prayer will get you to the right answer, if you call yourself Christian you should be displaying the Christian examples we are given
You shouldn’t have to leave your faith at home, it’s your best ally at work
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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We talk about setting the right mindset, culture and tone as a leader of the department and especially in smaller facilities
You don’t have to be perfect, but you can avoid the little negative comments and criticisms
Being a good example goes a long way
As a Christian we are supposed to act like Christ would
We have a lot of metrics we have to worry about as clinicians but, as Christians, we need to worry about the metric of mercy
Understanding that we are not as far removed from the homeless, drug addicted patient as we might think
We have to remember that, as we care for the homeless and drug addicted person that no one else will care for, we are doing it for Jesus
Brian tells his students to spend as much time with the patient as they need, you don’t have to be the fastest provider right away
We have to be careful about bias getting passed on from triage and from EMS reports as well, sometimes the problem is more subtle and requires more time with the patient
How we word things when talking with patients makes a big difference
We talk about providing respect and dignity to those patients that die
Brian talks about some on-shift practices he uses to re-center himself on his purpose
We talk about the grey area in which we practice in the ED
I try to practice assuming good intent on others
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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Has been an attending physician since 2019
Brian volunteered when he was a teenager in the ER and the staff that got him involved really drew him toward emergency medicine in med school
Brian worked in the ED as an EMT as well
He talks about early mentors and the impact they have, including helping him get loans for medical school
We need to remember to be like that mentor that encouraged us when we were new and pay it forward to the next generation of students
You must have something that drives you in emergency medicine, it is a difficult specialty. At first the dopamine drive from the excitement can carry you a ways but it will fade over time
Brian talks about how faith led him to where he is now
We talk about the fulfillment of just having good conversations with patients and making sure they feel cared for and understood
Brian talks about recognizing burnout, it’s a “general sense of not being whole” like something has been taken from you
He talks about the golden handcuffs of being a physician
Brian talks about how he overcomes exhaustion and burnout
Cold plunging - forces you to be in the moment, control you heart rate and breathing
Choosing hard things makes those hard things that are forced on you easier
Living in the moment is largely equated with happiness, the more you can do this the more you can be happy. Meditation and many other therapies are simply teaching you to keep your mind in the moment
A wandering mind is an unhappy mind
Prayer is another method for focusing your mind
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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Advice for the new EMT, paramedic, nurse, physician who is also a believer
Build your faith in the easier times so your faith doesn’t shake when times are hard
You have more reason than anyone on the planet who doesn’t believe to strive to do this job better every day, you are held to a higher standard
Adam still finds joy in emergency medicine, doing hard things, interacting with many different humans, seeking an answer, the intellectual stimulation
You must be able to embrace the hard stuff, embrace the suck
Adam talks about the priority he gives to family and being mentally present when he is physically present with his kids
He talks about the training that is required to make yourself mentally present outside of work and how to move on from a hard shift
“He told me to cast my cares to him because he cares for me”
Take care of yourself before you take care of others
In our line of work sometimes quality is better than quantity time
Adam gives the advice he would give to his younger self
He knows himself well enough to know he should say “Stay scared my friend,” because he can take that in stride and not panic. This job can be out to get you
You don’t know what you don’t know
Don’t step over the line between confidence and cockiness
Adam talks about some practices he has that allow him to move from ER physician mode to father, husband mode
Praise and worship music on the way home helps him
I try to remember to keep my eyes above the waves, like the story of Peter when he walks towards Jesus on the water
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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Faith and burnout
Adam talks about how he tends to spend his spare time reading the Bible, going to church, spending time in prayer and how this develops character and is better than pursuing time wasting activities or the easy dopamine dump that does not add to sustainability or self-improvement
We are designed to do hard things – mental or physical – including pursuing Jesus – this builds stamina, character and makes you better in your career
Choosing hard things makes the hard things that you don’t choose much easier to handle
Seeking hard, painful things can reset your own personal pain scale
We can find more reward and satisfaction in the suffering than the result, less satisfaction in being done
“Re-shift your mindset to find that the goal is the struggle and you are overcoming it”
Journey over destination
“The reward comes from striving, from the journey”
“That’s the example of Jesus”
We talk about the apostle Paul and his example
Social media skews our view of other humans; it polarizes us and makes us see the worst of humanity instead of seeing the good
There is some benefit to boredom
All sacred texts talk about the need to meditate on these things, allow yourself to sit in silence and seek what you are trying to find
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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Former paramedic and has been an ER physician for 7-8 years
He pursued emergency medicine after his experience as a paramedic because he feels it is more in line with his personality
We talk about how emergency medicine checks a lot of exciting boxes that we enjoy
Adam talks about his burnout symptoms as well as how he course-corrects
He talks about symptoms like lacking as much compassion/empathy as he should have. So he corrects by talking with his wife, focuses on getting enough sleep etc
He has let go, to some degree, of all the “techniques” we learn to combat burnout and refocused on his “why” – he knows his purpose. He was called by God to do this job
“Without question, I was called to be in this position by God – it changes everything”
Part of the difficulty of the ER is the sheer volume of people we see on a given day, in a lot of ways, we are managing a lot of mental health conditions in that volume – it can be an opportunity and a gift rather than just viewing it as something to get through. Seeing people as human beings
This perspective can help us avoid cynicism – I’ve found that assuming good intentions on the part of everyone I encounter during the day goes a long way towards avoiding cynicism and taking better care of patients
We must intentionally hold on to the victories, the grateful patient, the lifesaving situation
When you look for the good, you tend to find it
We talk about setting tone for the rest of the staff in the ED
We talk faith in emergency medicine as Christians, it has everything to do with everything that we do in life and in the job
“I would have chosen an easier job with an easier route to get to it if it wasn’t for God”
“The hope I have in Jesus sustains me”
Why do awful things happen to good people
Free will leads to the world we see and proves that we are not God, yet we are called to His standard
The potential of every human to do self-seeking, evil is why we see some of the horrible things we see, the answer is where do we take these burdens
I discuss my view of free will and its ramifications and our mission on earth as Christians
“Should only bring patience and kindness and hope to an interaction with another human who is suffering”
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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Give the escalating patients some room, you don’t have to be within arm’s reach
I talk about what a bad code blue looks like and what a good code blue looks like and how this translates to running a good code grey
Assign roles, we don’t have to surround every aggressive patient with a ton of people
Don’t join in the fight or flight mindset that the patient may be operating in
We talk about who should be lead in these situations and how we should be handling behavioral health emergencies when they escalate
We deal with staff and nurses leaving the field related to these negative interactions, so part of the goal needs to deal with the emotional toll it leaves on the healthcare individuals involved
Sometimes patients don’t choose the ideal plan that we may want for them, but we can’t let this burn us out and instead, focus on making a great alternate plan that will serve them
Josh shares a great personal story where he went above and beyond to help a grieving family member that still remembers him from a decade ago
Sometimes all we can do is plant a good seed and the harvest is much later
Great customer service is an important concept, respect and dignity, empathy and understanding
Fight to understand, not fight to win
We have to frequently check our bias, we can miss opportunities and even medical emergencies if we write off a patients behavior as just a behavioral issue
We cannot help others until we take care of ourselves
Hydrate, use the bathroom, eat while on shift
We are all at risk of developing cynicism from negative encounters, so we have to be intentional of seeing the good
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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Josh has 20 years in Public Safety
Currently doing crisis prevention instruction
We often don’t get any education in med school or PA school in how to communicate well with patients or how to de-escalate their behavior
Code greys are the behavior health emergency response; someone has some concern that a patient is escalating to potentially violent behavior and a team will respond
Staff safety is priority
We are there to provide excellent medical care, if it’s safe to do so
We recommend calling code greys earlier to avoid worsening scenarios
Code grey assures staff safety then de-escalation of the patient
Recognizing when you need help with patient interaction from some other staff member is important
Typically, negative behavior is a result of an unmet need or want
Rationally detach
Give people options, this helps give them a measure of control when they feel out of control
Get consent to do a physical exam, taking that extra few seconds to explain what you’re doing and getting that quick permission goes a long way
We forget that we ignore many social norms in the ED, patients may not be used to this
Always introduce yourself
A huge component to de-escalation of patients with negative and violent behaviors is that, if not done properly, they are a primary source of burnout. They become a huge negative experience that it sticks with you, not to even speak of the potential for an injury. Avoiding these negative experiences at all costs will be key to thriving in emergency medicine
Josh talks about a severe ankle injury he sustained and how he found a way to keep helping people anyway. He talks about how he strived to get the struggling people back connected to community. He helped them re-establish trust in others so that they could accept help
We talk about the resources available for financially struggling patients
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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Lucas gives his pitch for why it is still worth it to be a physician - it’s one of the best jobs in the world but you have to have the ability to adapt to change over time
Being a physician still allows you a rewarding, stable and consistent job. A comfortable lifestyle. Job portability
As a PA, this can be even better because you can switch between specialties
Our variable schedule in the ED has its cons but it has a lot of pros as well
We talk about things that we find rewarding in emergency medicine
Even the non-work-related rewards when we often do nothing at all but reassure our family, our friends is fulfilling
The cascade from relieving anxiety and saying “you are okay” is powerful
A brilliant ER mind said “Don’t just do something, stand there”
If you are well, aggressive medical interventions are more likely to harm you than help you
Take care of yourself, take care of your relationships, the lone wolves die, humans need other humans to survive
In your journey in a career that is very difficult and very easy to burnout, the rewards are much more magnified on the other side. The rewards are much more in your control than you think. With the right mindset you can change how rewarding your career will be
This is an amazing setting, you have one of the coolest jobs in the whole world
What other job is there where you see people on the worst day of their lives, save a life and can allow other people’s lives to touch you
There is an honor to be there on someone’s worst day
Intentionally look for the positive, it is there
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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Longevity in a tough field is something you need to consider as well as the right mindsets that keep you there – be intentional about being grateful
Lucas gives some advice in doing triage shifts and focusing on the good people you have the privilege to interact with and trying to be intentional about not focusing on the mean, angry patient
Intentionality behind the things that improve your well-being are more important to prioritize than you might think
Allow your family, significant other to help you
Fatherhood and dual income houses are more the norm now so both parents have to work toward raising children and working
Lucas gives advice to the new ER physician
The busier you are, the more stressed you are, the more you need to maintain hobbies
The PA profession has done a good job of setting people up for success with having a good work and life balance
Community is super important to cultivate, the lone wolf dies
It can be easy to justify allowing relationships to wane when you are busy in medicine and education, but this cannot be put off forever
Break the pattern of pushing off community in favor of career
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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ER physician for 15 years
He talks about this path into med school and emergency medicine as his first choice
He likes the challenge, lack of predictability and wide scope of problems we must solve. We have the honor to accept patients when no one else will
Lucas talks about how the term emergency medicine is almost becoming antiquated when we are doing acute, undifferentiated care
Some of the care is emergencies, but not all. And that’s probably for the best so we don’t get burned out
He talks about burnout and how we should focus on how to manage it when it happens as opposed to how to prevent it all the time
You need to accept that burnout will happen, so you don’t have an expectation mismatch
Being aware of your own burnout is key to correcting it
Optimizing the other things in your life outside of work like exercise, nutrition, community is key
Be intentional about focusing on the enriching case, appreciative patient, positive conversation you have throughout the day. If you look for the positive you will find it and then do whatever you need to do to get it in your long-term memory
Lucas talks about gratitude and how this requires intentionality as well
We talk about how much to share with spouses
We talk about the role of the clinician in the ED and how we have a lot of things to manage that other staff may not see
We talk about how to manage our limited resources
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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Leave work on time
•David’s story: a skilled, compassionate paramedic who deeply connected with patients, especially during psychiatric crises.
oStruggled to separate work from life.
oRelied on alcohol as a coping mechanism, which ultimately cost him his life.
•Core lesson: In emergency medicine, you must leave work at work—emotionally and physically—otherwise burnout and unhealthy coping are inevitable.
•Healthy separation:
oBalance connection with patients while avoiding over-identification.
oRemember: “It is not your emergency.”
•Practical strategies to get off on time:
oCheck labs/imaging in real time.
oComplete charting as you go.
oPlan handoffs 1–2 hours before end of shift.
oControl what’s controllable—systems, shift crossover, advocate for better staffing.
•Mental discipline:
oSet down burdens from tragic or unjust cases (e.g., drunk drivers, preventable deaths).
oFind something greater than yourself (faith, higher power, or another anchor) to release what you can’t control.
•Work–life balance:
oCreate a clear line between work and home (physical transition, dedicated space, or ritual).
oAccept that some seasons demand more grind, but don’t let it become a lifestyle.
oYour family will notice the time you miss more than your employer ever will.
•Identity check:
oYou are not your job title; resilience and character matter more.
oOver-identifying with work justifies staying late and sacrificing home life.
•Universal takeaway: No matter the field, burdens from work will bleed into family life unless you intentionally lay them down. Getting off on time = preserving resilience, family, and long-term health.
Chapter 3: Take Care of Yourself Before You Take Care of Others
•Past struggles:
oPrioritized school and work over health.
oPoor sleep, binge eating, energy drinks, inconsistent workouts.
oLack of discipline → foggy brain, poor performance as a paramedic.
•Core principle:
oYou cannot care for others well if you neglect yourself.
oIn EMS/ED, emergencies are unpredictable, but most patients are not crashing—there’s time to hydrate, eat, and reset.
•Practical applications:
oDrink water, eat proper nutrition, and rest before/during shifts.
oPrioritize morning routines (hydration, exercise, food) → sets the tone for the day.
oMeal prep to avoid cafeteria junk food and impulsive choices.
oCreate habits that are accessible (water bottles, packed meals).
•Mindset shift:
oCaring for yourselfSupport the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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Introduction
My first experience with a cardiac arrest as a new EMT → exhilarating, confirmed calling to emergency medicine.Early struggles: dropped out of college, lacked discipline, but EMT training provided a direction and purpose.Spent years balancing work as EMT/paramedic with school → long path to becoming a PA.Lessons from emergency medicine shaped clinical skills and mindset.Concept of standards:Standards = benchmarks, measurable expectations, non-negotiable habits.Different from principles (general truths) → standards are concrete, either met or not.Standards build consistency, resilience, and preparation.Personal struggles: binge eating, lack of discipline, repeated failures to meet daily goals.Turning point: completing 75 Hard program → developed discipline, consistency, higher personal standards.Standards spill over into clinical performance, family life, and personal growth.Emphasizes locus of control:Focus on what you can control, not external factors.Even in chaotic emergency medicine, there are controllable elements.Warns that neglected habits eventually become emergent problems (health, mindset, life).Family story: father’s heart attack → personal wake-up call about health and discipline.Core message: Raising standards in personal life and medicine leads to thriving, not just surviving.Purpose: help others raise their own standards without taking 16 years to learn the lessons.Chapter 1: Do Not Seek to Diagnose
Case study: elderly woman with shortness of breath and chest pain.No pulmonary embolism, but fluid in lungs and around heart → problem found, but no definitive diagnosis yet.Highlight: in the ED, the goal is to rule out life-threatening conditions, not always find the exact cause.Key principle: Diagnosis is often less important than identifying and stabilizing dangerous conditions.Emergency medicine limits:Not every test or long-term treatment available.Focus on acute, life-threatening issues; leave underlying cause to specialists.Patients often expect answers and certainty, but ED care is about safety and ruling out the worst cases.Overdiagnosis problems:Incidental findings (lung nodules, brain aneurysms, ultrasound anomalies) → create stress, anxiety, or unnecessary proceSupport the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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Advice for new EKG techs:
Trust your knowledge and build your confidence over time, stay calm and take deep breaths when you start to get busy
Stay humble, ask for help
No one comes out of school knowing everything, you need to know your limits
Regardless of your role, don’t be afraid to advocate for the patient
Providers need to remember to project an approachable demeaner so that everyone has a level of comfort bringing things to their attention
It’s important to take your job seriously and do it to the best of your ability
Cheyenne talks about the stress of scribing
Sean talks about some frustrations he has with nursing putting in frequent EKG orders without the right indication
We talk about some of the specialties within cardiology
If you are looking into getting into medicine, look at EMT or EKG tech. They both give you a great insight into the greater medicine world
There are a lot of great jobs that introduce you to medicine before you take the risk of PA school or medical school
Sometimes the only way to really understand what you are getting into is to get into the field instead of reading about it or watching videos about it
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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We talk about stat vs routine EKG orders as well as metrics that they are always working to hit on time
When EKG’s are not done on time the source of the problem needs to be found, sometimes it is the providers’ fault for not realizing the EKG order had not been placed
We talk about how we should communicate between provider and EKG tech and how much info we like to get as providers
I talk about how providers need to become good at task switching frequently and this includes signing EKG’s
We talk about the responsibility of the PA or NP to sign EKG’s (calling STEMI’s or deciding not a STEMI) and how this responsibility is currently in the hands of the physicians only
Sean talks about how important EKG’s can still fall through the cracks at times and people will still point the blame all the way back to the EKG tech
It’s important to make sure you do your job well and then realize some things are out of your hands
Cheyenne talks about an experience she had with an end-of-life patient she cared for
Even being just peripherally involved in a patient’s care can really affect you emotionally
Avoiding burnout:
Cheyenne likes to go to the gym or hang out at home with her dogs
Sean talks about how he avoids burnout doing a job that can sometimes be repetitive
Sean also talks about the importance of calmness in front of patients, even when an EKG might be alarming
Don’t sweat the small things, especially in the ED, everyone is under a lot of stress, and you can’t allow a small comment from a stressed-out coworker to get under your skin and make you spiral
Sean talks about some methods to reassure patients despite not being able to diagnose their EKG
We talk about the importance of stress management in the ED so that you can think clearly about the next patient
It is not your emergency, we must be the calm in the storm
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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Welcome to the show Sean and Cheyenne, EKG tech experience and scribe experience
Sean talks about certifications and expectations that go beyond merely obtaining an EKG as well as the stress testing role
Cheyenne talks about the role that scribes play in the ED
Scribing for providers is often used as a role to gain patient experience for medical school or PA school
They talk about how they got into scribing and EKG technician work and Sean talks about how it is also a role that is used as a steppingstone
12 leads are complicated to interpret and require a lot of training and experience to get good at. They are even harder to interpret when the patient is not in front of you
STEMI’s are the key EKG’s to recognize because they are so time sensitive, but we don’t see these frequently – it can be very helpful when the tech recognizes this and can recognize the urgency
Knowing early signs of impending problems on the 12 lead can be helpful for patient prioritization as well
Being an EKG tech requires good resource utilization, sometimes there are not a ton of EKG techs available in the hospital, so they need to prioritize – communication is key
Communication between roles is so important when we are trying to get quickly get imaging, labs, assessments and EKG simultaneously
At the end of the day, the patient is the top priority
Scribes do deal with a lot of stress, they must finish notes, write new notes and keep up with high volume, they like active communication with the provider
Sean talks about how a typical day can vary quite a bit
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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I’d like to welcome to the show Dr. David M. Berry, MD, he is a growing voice in the recovery and addiction space, an area that we deal with a ton across EMS and the emergency departments. He is an Emergency Medicine physician with over two decades of experience.
You can reach him at [email protected]
Burnout and moral injury – how do we avoid these in dealing with the addicted and psychiatric patients? We can’t control most factors involving their long term care but David says: “give these folks the best care I know how to give them.” We can control what WE do
We talk about the best way to communicate between providers when passing on patients to the next shift
Dr. Berry talks about a patient he advocated for that he felt needed in-patient psychiatric admission but had been initially turned down
He talks about the importance of working patients up appropriately and not ignoring patient complaints, getting the emotion out of it
What would you do objectively if the patient was not a frequent flyer?
Dr. Berry talks about a substance use clinic he helped open in Western Colorado
He talks about meth addiction and how recovery works in his clinic
He tells a story about the devastating effects of meth on a young patient
The danger of meth is not in the withdrawal but the effects of it on your body
Dr. Berry talks about the limbic system, the reptilian part of our brain. People who struggle with addiction have a missed connection. Normally, when the average person drinks, a message gets relayed back from the brain saying slow down, you have responsibilities, you have work, you have a family. The addict’s brain doesn’t send this message back, they just get the message to drink more cause it feels good. This applies to any addiction
Their decider is broken, that’s why they need a sponsor, and their brain can eventually rewire and make the needed connections
The anatomy problem of missed or failing brain neurons is what is going wrong in the addict’s brain
This helps us understand where the blame truly needs to be placed, not on the addict for poor moral character or poor self-control but on a brain that isn’t wired correctly
Winston Churchill said everyone has an addiction, the key is finding one that is socially acceptable
Dr. Berry talks about Recovered on Purpose, an organizat
Support the show
Everything you hear today from myself and my guests is opinion only and doesn’t represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions. This is not medical advice. If you have personal health concerns, please seek professional care.
Full show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, Paramedics
Most efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours.If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you.
1st Phorm | The Foundation of High Performance Nutrition
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